CHALLENGES IN THE MANAGEMENT OF TEETH WITH EXTENSIVE STRUCTURAL LOSS AFTER ENDODONTIC TREATMENT

Abstract

Endodontically treated teeth present increased susceptibility to fracture, mainly due to the loss of dental structure and associated biomechanical changes. The restorative management of these teeth, especially when there is extensive structural compromise, represents a significant clinical challenge and requires an evidence-based approach. The present study aimed to analyze, through a narrative literature review, the main restorative strategies and biomechanical factors involved in the rehabilitation of teeth with severe structural loss after endodontic treatment. The databases PubMed, Scopus, and Web of Science were consulted, including studies published between 2021 and 2025, such as clinical trials, systematic reviews, and laboratory studies. The findings indicate that the amount of remaining dental structure is the primary determinant of restorative success. The presence of a ferrule is associated with greater fracture resistance, while intraradicular posts play a fundamental role in core retention without providing significant structural reinforcement. Fiber glass posts exhibit more favorable biomechanical behavior, with better stress distribution and a lower incidence of irreparable fractures. Additionally, endocrowns have shown to be a conservative and effective alternative, with performance comparable to conventional restorations in selected cases. It is concluded that the success of restorative treatment depends on individualized planning, maximum preservation of dental structure, and appropriate selection of technique and materials, favoring minimally invasive approaches and greater clinical longevity.